Galen’s Anatomic Vision and Chinese Axonometric Drawing

Presented in the Eighth Annual VCU Symposium in Architectural History

East Meets West 

Qi Zhu  

September 2000

Abstract

This paper focuses on the discussion of Galen’s and the traditional Chinese anatomic vision, and their influence on the traditional Chinese axonometric drawing. In the process of investigation, it gradually becomes clear that Galen’s anatomic vision, founded on his advanced knowledge of anatomy, is a logical thinking of the relationship between structure, form and function. It intends to visualize what is real. But the Chinese anatomic vision is a bodily perception. By perceiving the dimmest manifestation of changes of color and expression on the faces, the subtle changes happened inside the body is transferred to visuality.  However, although Galen’ anatomic vision and the Chinese’s look in reverse direction, they are not contradicting with each other at all. Only the artful union of these two anatomic visions can lead to the true understanding of the dimension of depth of the body.

The investigation in the depth of body is then directed to the investigation in the depth of space. In the second part of the paper, axonometry, as a means of representing the depth of both the structural and perceptual space, is explored. Then we reach the understanding of the traditional Chinese axonometric drawing as a form of expressing perception.

Introduction

Since beginning my studies in the United States, differences between Chinese and Western culture always surprise me. Here describing a person’s appearance by their hair color, such as blonde, red or brown, is so prominent feature, but to me quite often is invisible, because the hair color of the Chinese is all black. The visible and the invisible thus appear and disappear under different cultural frames.

Medical treatment is another area of differences between east and west. An acquaintance of mine strained a muscle during a weekend hike, and then constantly suffered from severe pain in her right leg. Her doctor diagnosed sciatica, a pinched or compressed sciatic nerve, which causes lower-back and leg pain. He prescribed stronger pain relievers and a week of bed rest. They did not help. She was referred to an orthopedist who performed Magnetic Resonance Imagining test (MRI) and more medication was prescribed. After five months, she was still hurting. By chance she was advised to find a Chinese doctor for an ancient needle therapy. After the acupuncture treatments, her pain subsided.

In this case the western doctor went directly to the affected area of the human body, while the Chinese doctor although lacks anatomic knowledge, and seemingly indifferent to it, carefully manipulated needles on various sites of the human body. In the clinical practice of Chinese medicine, for a headache the doctor often puts acupuncture needles into the patient’s fingers. This sort of things leave the Western doctors shaking their heads in amazement and asking, “ will things really work out that way?”

The story is not to claim that one approach is superior to another, but to reveals the profound difference in anatomic vision between the two cultures. This divergence is not new, but has a long tradition, tracing back almost 2000 years. When western doctors were beginning to study the interior of the body through anatomy, Chinese doctors, on the other hand, were practicing how to perceive the inside of the body through the indications shining on the surface of the body. When Galen was commending on how the parts of the body perfectly match their functions, the Chinese counterparts were pondering upon the totality of the body, reading body as a microcosm.

In the first part of this paper, I discuss the two different types of anatomic vision: Galen’s anatomic vision and the traditional Chinese’s anatomic vision and propose that these two types of anatomic vision in medicine, although opposites, indeed, if interlinked, could lead us to a deeper understanding of the depth of body

I then show how these anatomic visions are not restricted to medicine, but also appear in architecture representation. A case in point is Chinese axonometric drawing, the dominant traditional means of expressing the depth of both the structure and the perception of the space. The two kinds of anatomic vision were cast into the Chinese axonometric drawing. 

If the anatomic vision tells us how to observe, and the axonometric drawing tells us how to represent, this paper is aimed at understanding representation from the perspective of observation. I hope the emphasis on the anatomic vision could help us to see into the depth, discover the traces that are otherwise invisible.

Body Perceived in East and West, Cover Image of The Expressiveness of the Body by Shigehisa Kuriyama

Galen and His Anatomic Vision

Galen was an influential Greek physician, active in the second century (129-200 AD). He was a son of a prosperous architect, Nikon, who named him Galenos, meaning mild, perhaps in the hope that he would turn out differently from his mother, who was very irritable.  He wrote of his father with respect; who gave him an excellent education in literature, philosophy, sciences, and finally sent him to Alexandria to study medicine after being advised in a dream to make him a physician.[1] Galen established a large and fashionable practice in Rome. However the success in his medical practice did not make him uninterested in studying philosophy, because Galen believed that the best physician should also be a philosopher. He constantly condemned those physicians who were ignorant and materialistically minded, and urged physicians to emulate Hippocrates. Galen himself venerated Hippocrates as his teacher, and like him, labored unceasingly in the pursuit of knowledge and truth.

Truth, for Galen, is not simply the belief in the observational data, although Galen is very faithful to them. In Galen’s mind, blindly following the obvious observational data raises fundamental problems. For example, in the treatment of the sick and similarly in dietary prescriptions, it ought to be possible to dispense with speculation and rely completely on experience, as the doctrine of the Empiricists says that only observation of the symptoms of diseases, of evident causes like hunger and thirst, rest and fatigue, and of the effects of remedies mattered in medicine. Galen was sympathetic to the Empiricists, as he puts it, they were not satisfied with one or two observations, but demanded repeated testing in the same disease of what had been noted to be helpful. Only if the effect proved constant in the majority of cases did they consider it a reliable fact[2].

For Galen, those “reliable data” were still not reliable. Galen decides the allegedly constant results are still due to chance. The Empiricists rely on them and do not dare to deviate from them, regardless of what the circumstances of the case may require. In that sense, they are wrong, Knowledge of the nature of the patient, of the condition of the disease, of the power of the remedy, as well as the right moment for its administration, is required. This has to be obtained by theoretical consideration and then confirmed by experience. Galen, then, systematically constructed his theoretical consideration, which derives not from pure experience, but from his practice in anatomy.

Galen’s anatomy includes experiment on the living animal. By tying and untying the ureters Galen proves the flow of urine from the kidney to the bladder; he severs the spinal cord at different levels and describes the ensuing loss of motion and sensibility. He ligates the recurrent nerves he has discovered and notes the subsequent loss of voice. Experiments may be difficult. If they do not succeed at first, the attempts must be repeated.[3]

For a modern reader who is familiar with Galen’s anatomic knowledge, it seemed that, while Galen’s anatomy might be transferred almost unaltered into a modern textbook, the same couldn’t be said of his physiology. Why? In the following section, we will discuss that it is Galen’s particular anatomic vision that sees his anatomic knowledge in a different form than what we have today.

Galen’s Practice of Bloodletting and His Vascular Anatomy

Draining blood as a very idea of nurturing life has been practiced for a great part of Western history. Embraced as “the great beginning of health”, bloodletting promised a limitless horizon of virtues: “It makes the mind sincere, it aids the memory, it purges the brain, it reforms the bladder, it warms the marrow. It opens the hearing, it checks tears, it removes nausea, it benefits the stomach, it invites digestion, it evokes the voice, it builds up the senses, it moves the bowels, it enriches sleep, and it removes anxiety… “[4]  “A bleeding in the spring is physic for a king…”summarized an old English adage. Galen let blood for such sundry ailments as gout and arthritis, dizziness and blackout, to list merely a few. He declared phlebotomy “an essential remedy”, called for “in any severe disease” and he supposed this belief to be entirely traditional.[5]

Why is Galen so enthusiastic about bloodletting? Is his advanced anatomic knowledge giving him support? To answer those questions, let us look at Galen’s practice of bloodletting and his vascular anatomy.

In Galen’s practice of bloodletting, he is very definite about the importance of using the correct side of the body. The beneficial effect of hemorrhages on the same side of the lesion, he says, can be observed daily in patients:

If you revulse on the same side as the lesion, says Galen, the patient’s relief will be quickly evident; if you open a vein on the opposite side it does not help at all.[6]

However, Galen’s practice of revulsing at the same side of the lesion seems not be supported by the knowledge he obtained from his anatomy, as discovered by Peter Brain in his book about Galen, Galen on Bloodletting. Brain wrote:

To explain this, if we try to ascribe the reason as the pure faith of Galen to His esteemed teacher, Hippocrates, it is questionable either. Bloodletting can be traced back to the practice of Hippocrates. But according to the study of Peter Brain, he concluded that the approximately 70 references to letting blood in the Hippocratic corpus earn it only a small place on the map of Hippocratic therapeutics.[9] No treatise or even extended passages develop an explicit theory of phlebotomy. The idea that Hippocratic physicians touted bloodletting as the most effective of remedies of Western medicine is a myth. Bleeding became a prime pillar of Western medicine only later, in Galen’s time. Meanwhile, from other extracts that are contemporary to Galen’s and still exist today, it seems clear enough that there was little agreement in the part of other authorities, either with Galen or with one another, on the point in question. Why, then, did Galen believe in revulsive bloodletting from the affected side of the body while his own anatomic knowledge does not offer any basis for this belief? Known from other records of Galen, Galen is so rational elsewhere, even if his premises are wrong, that it is strange to find him behaving, as it would seem, so very irrational here. Why does this happen?

Galen’s Anatomic Vision

If we make a judgment on the above description, saying that Galen’s therapeutic methods are not founded on his anatomy, it is obviously wrong. Galen does appeal to anatomical demonstrations to justify his practice. In his work on Tremor, speaking of the maid-servant of Stymargos and Hippocrates’ reasons for bleeding from the legs, he says:

That it is necessary to use phlebotomy when there is a plethos of blood is, I think, clear to everyone, for the blood is contained in the veins; but you would not be able to follow the argument that in disorders of the uterus, the incision must be made in the region of the ankles or in the ham, unless I were first to demonstrate you, by dissection, the connection of the veins. For a particular vein communicated with a particular part of the body, and one must always make the evacuation through the connecting veins.  If you were to incise the veins that do not communicate at all with the affected part, you would not heal the affected part, and you would always do damage to the healthy one.[10]

So the point in question could only make sense if it is admitted that Galen evidently saw the matter in a totally different light. Although Galen never explicitly talks about his particular way of seeing, we can find the traces of it almost everywhere in his writing. At the end of one of his major works, On the Natural Faculties, Galen compares blood vessels with the irrigation system of a garden, which explains that it is his particular anatomic vision, founded on his anatomy, that leads to his particular physiology. Galen wrote:

You may learn this most clearly from irrigation furrows in gardens. For from these furrows some moisture is distributed to all the parts lying alongside and nearby, but it can not reach to the more distant parts, and hence the gardeners have to arrange the flow of water to each part of the garden by cutting many small furrows leading off the big one, and they make the spaces between these small furrows of such a size as they think will best allow them to benefit by drawing from the moisture that flows to them from every side. It is the same in the bodies of the animals. Numerous conduits distributed through all the limbs bringing them blood just as an irrigation system distributes water in gardens.[11]

Therefore the body is like a large level garden, watered by the spring in the middle; this is corresponding to the new blood that is formed in the first veins in the region of the liver. From here, irrigation furrows lead in various directions. The diagram below shows the principle furrows; they must be imagined as giving rise to many smaller ones, which in their turn do the same, so that no part of the garden is without some furrows close at hand. The ultimate subdivisions of the furrows end blindly, and the water in them soaks into the ground to nourish the plants; as it soaks in at the periphery it is constantly being replaced from the spring at the center, so as to keep the furrows full. There is no circulation or rapid movements of water at all, only a slow seeping from the center to the periphery to make up the loss there. Plethora requires evacuation before the plants suffer from an excess of water; this is achieved by making a breach in the wall and allowing the water to escape, presumably into a low-lying region which might be imagined as lying adjacent to the garden. Not all the furrows are accessible to such treatment; one cannot, for example, let blood from vena cava.

This simple analogy is extended from treating the plethora in the liver to other diseases. A patient bleeding from the right nostril, at E, must according to Galen be revulsed on the same side of the body. The region at E is nourished by the vein that encircles the clavicle (modern external jugular) and if this vein could be opened the hemorrhage would be stopped by derivation. It was not Galen’s practice, however to open veins in the neck, and the accessible vein that was most directly connected with the one that concerned was therefore used; this is the humeral (modern cephalic) in the right arm, at F.  To use the humeral in the left arm would draw blood first from the parts most intimately connected with it, which are those of the left side of the face, and this would merely weaken the patient without having a prompt effect on the right side of the face at which treatment is directed. Galen was well aware that there were interconnections between all the veins, as are there between the furrows in the garden, but prompt results were desired; no gardener, after all, would open the furrow at G when the land at E need draining.[12]

As far as we can determine from the extant literature, then, there is no evidence that there was in Galen’s time a strong and orthodox body of opinion which held that blood ought to be let only from the affected side of the body. Galen’s decided views on this subject appear to have been almost peculiar to him. To the modern reader, who is aware of Galen’s advanced anatomical knowledge, they seemed at first sight quite irrational. However, once his revulsive practices are examined from his own point of view rather than that of a modern, it becomes clear that his advanced anatomy, far from contradicting them, in fact, lends them support.

In summary, Galen’s anatomy provides a structural system of the body. His anatomic vision gives the structure a specific form. His anatomic vision is no more than a mental thinking, the logic of which derives from his metaphorical construal of nature and body. In his writings, he constantly uses metaphor to decipher the myth of nature in the perfect fit between the forms of the various parts of the human body and their functions. The anatomy is not an end in itself, but gives foundation to his particular anatomic vision.

The Ancient Chinese Anatomic Vision

To the ancient Chinese, it is not unknown to dissect the body and study the interior structure of the human body, but the anatomic inspection left only faint impression on their concept of body. When the doctors inspected the body, they did not see the nerves and muscle that the Greek anatomist found so arresting. They lingered instead on the measurements that Galen and his predecessors entirely ignored.[13] Yet indifference to anatomy did not mean a slighting of the eyes. Not at all: the ancient doctors evinced great faith in visual knowledge. Like their Greek counterparts, they scrutinized the body intently. Their anatomic vision sees the dimmest manifestations of changes of the color (se, 色) on the faces. [14]

Consider the legend of Bian Que[15] 扁鵲, the most celebrated name in the history of Chinese medicine. Originally we are told, Bian Que had no connection to the healing arts. He was managing a boarding house when, one day, an aged boarder named Chang Sang Jun, (長桑君) drew him aside. “ I possess secret skills,” the guest confided, “ but I am old, and want to pass them on you.” Producing an elixir, Chang Sang Jun advised, “ Drink this with fresh drew for thirty days, and you will know things.” Bian Que did as he was told, and soon discovered that he could see through walls and inside bodies,[16]

Penetrating insight was thus key to his transformation into “the Hippocrates of China”. Bian Que’s name became synominous with medical acumen partly because he could see through. Of course, this evidence also intimates a telling difference: visual knowledge in Chinese medicine was mostly a matter of diagnostic sight. It engaged a gaze trained in living persons rather than on lifeless corpses. This accordingly is the main focus of how Chinese doctors scrutinized the living.

The solution of Chinese doctors was to gaze upon the surface. To the anatomical eye, the skin is an occluding screen, blocking insight into underlying forms, and a body without forms is but uninformative matter, darkly inscrutable. But in China, the skin shone as the site of privileged revelation. For there, at the surface, doctors contemplated a person’s se. If Galen scrutinized the functional meaning of organic shape, healers in Han-dynasty China peered into the profound significance of hue.

But if the Chinese concept of “se 色” could be understood in a deeper layer, we could find that “se” in the Chinese anatomic eye, does not simply means “color”. The visual knowledge of se, in fact, structurally links with the phenomenal expressiveness of face. In modern Mandarin, Yan顏 se色 is the standard word for color. To learn the hue of hair, you asked “What is the yanse 顏色 of the hair?”. But the word yanse is an ancient term and figures already in the Analects. But for Confucius, it had a rather different sense:” Confucius said:”

When in attendance at a gentleman, one is liable to three errors. To speak before being spoken to by the gentleman is rash; not to speak when being spoken to by him is to be evasive; to speak without observing the expression on his face (yanse) is to be blind. Yanse here means not color, but the facial expression. [17]

The character yan 顏 designates the face, or more precisely, the forehead, and from this one might suppose that se色 by itself meant something like look or appearance. In Chinese, the word Jise 飢色 (hungry air of the people), xise 喜色 (joyful air of the people), youse 憂色 (woeful air of the people) all use se as the description of the phenomenal expression of the face. Another meaning of yanse is “ the air (spirit) appeared at the forehead” or “the spirit of the face” as explained as the orignal meaning of yanse in modern Chinese dictionary (Ci Hai 辭海). The mind appears in the spirit (qi 氣), and the spirit appears in the forehead.  Eventually this se is associated with color and with the rise of five-color and five-elements analysis.

Hence Wangse 望色 becomes a subtle diagnostic art, inspecting the phenomenal expression of the face which is believed to be the expression of the inner mind and inner qi 氣, the phenomenal variation of color which is a signifier of the variations of the changes of the five elements in the body.

Wang and gaze of se is the primary analytical framework of the Chinese visual knowledge. However to Galen, it is not absolutely unfamiliar. That the predominance of yellow or black bile, phlegm or blood appeared in facial hues of yellow or black, or white or red, also was taken into account in the Greek physicians. Galen could even identify sight with the apprehension of chromatic change. The second century treatise on physiognomy by Polemo includes several chapters on the interpretation of complexions. Just like the reasoning according to the anatomic dissection becomes dominant in Western medicine, se in Chinese medicine engaged an intensity of interest and had a range of significance unmatched by colors in Greek medicine. That the Chinese healer’s day-to-day practice of inspecting the subtle expressive phenomenal changes on the face, invisible to Galen, makes the Chinese anatomic vision a divine art. This divine art becomes well known with the spreading of the famous story of the legendary physician Bian Que扁鵲:

Bian Que passed through the state of Qi. The Duke of Qi invited him to be his guest. But when he was received by the Duke, Bian Que looked at him and warned him, “ my lord has a disease which lies in the pores. If it is not treated, it will sink deeper.”

Duke Huan replied:” I am not sick.”

Bian Que left. Duke Huan remarked to his attendants, “physicians are greedy. They want to take credit for curing people who aren’t sick.”

Five days later, Bian Que was received again. He warned the Duke, “ my lord has disease which lies in the blood vessels. If it is not treated, I fear it will sink deeper.”

The Duke replied, “ I am not sick.”

Bian Que left. The Duke was displeased. Five days later, Bian Que was received again. He urged the Duke, “ My lord has a disease which lies in the stomach and intestines. If it is not treated, it will sink deeper.”

Duke Huan did not respond.

Bian Que left. The Duke was displeased. Five days later, Bian Que was received again. Gazing at Duke Huan from a distance, he retreated and rush rapidly away. The Duke sent a man to ask Bian Que about the reasons for his behavior. Bian Que explained:” When the disease lies in the pores, it can be treated by poultices. When it lies in the blood vessels, it can be cured with needles. When it lies in the stomach, it can be treated with medicine. But when the disease lies in the bone marrows, not even the God of Life can do anything about it. The Duke’s disease now lies in the bone marrows, and for this reason, I have no more advice.”

Five days later, the Duke felt ill. Someone was sent to summon Bian Que, but he had already run away. Duke Han subsequently died.[18]

This cautionary tale interestingly demonstrates how the Chinese doctors’ anatomical eye cuts metaphysically into the body and reads the logic of the depth from outside. This mysterious and almost divine art is obtained only through years of meticulous practice, like the Chinese doctors working on the traditional medicine still do so today.

Galen lingered in the flawless fit between form and function, marveling at how the form of each organ perfectly expresses its use. The form becomes that form only after Galen sees directly the inside with his anatomic eye, and then correlates back to the outside. However the ancient Chinese doctors never bother themselves in searching for the form like that in Galen’s eye, believing it is just non-informing APPEARANCE and shape. The only true form is actually the formless harmonious composition of Ying and Yang. Therefore they choose to watch from the outside and cuts through the body imaginally. The depth of the body and the status of different places inside the body are perceived through the invoking phenomena displayed on the surface of the body. Although these two kinds of anatomic vision see in reverse direction and seem fundamentally different, they all inspired by the same curiosity to the depth of body and all intended to grasp vertically to the interior of the body. The two manners, of which the two kinds of anatomic vision adopted, are complementary rather than contradict with each other. In fact, only though the crafty interweaving of these two kinds of anatomic vision does the comprehensive understanding of the dimension depth be grasped.

Surprisingly, joining the two kinds of anatomic vision is not new. We can carefully read the joint of them in the traditional Chinese axonometric drawings, which are aimed at representing the depth of both the structure of the space and the perception of the space.

Anatomic Vision in Axonometric Drawing

Axonometric drawing has a long history in both Eastern and Western cultures. In the west, it could be found in the representations on the classical Greek vases, on frescos of Pompeii, on Byzantine mosaics and in the Italian Renaissance. But the development of axonometry is not a linear course; rather it developed in several separate segments with only sporadic and short appearance. According to the study of Yve-Alain Bois, the real development of axonometry evolves from the problems of presentation which have confronted architects since about 1500 A.D.[19] At that time, they were searching for a graphic means to convey the synthetical impression of the building as well as having analytical function. When the pictorial representation of the “open” interior of the buildings comes out, it was quickly being adopted. But most of them are still perspective sections. The real innovation of axonometry comes from those studies of details, in which the vanishing point lies in the far distance, almost in infinity. The perspective projection is thus transferred to parallel projection. Hence axonometry becomes a particular kind of drawing, which conveys the synthetical impression and is closer to the fact than to the appearance.[20]

The evolution of axonometry tells us that in the western culture, it belongs to the categories of geometric projection.  The geometry is the hidden structure, and the drawing of axonometry, like Galen’s acute anatomic vision, tells the architect the totality of the building otherwise invisible if viewing from a particular perspective.

In Bois’s article “Metamorphosis of Axonometry”, interestingly he also mentioned that axonometry originated in ancient China. Although this assertion needs to be investigated further, on another aspect, it claims the special status of axonometry in the Chinese world of representation.

Unlike the concept of axonometry in the west, the Chinese axonometry does not aim at offering a synthetic expression of either the object or the space, but more oriented at the expressiveness of the depth of both the structure of the space and the perception of the space. To achieve these, the traditional Chinese painter is trained to have a pair of anatomic eyes, which possess not only the traditional Chinese doctors’ anatomic vision, but also Galen’s.

The Chinese Axonometric Drawing, Jie-rule Painting

Before we start to elaborate on how the two kinds of anatomic vision was cast into the traditional Chinese axonometric drawing, we need to be aware that the term “axonometric drawing”, invented in the western culture, is intimately associated with geometry and measurement. The Chinese term for axonometric drawing is totally different, which has nothing to do with geometry. It is called Jie-rule painting, named after the tool that is used for making this kind of painting. From the conceptual difference of the two kinds of naming, the conceptual difference between these two kinds of axonometric drawing is therefore quite evident. The Chinese jie-rule painting is inherently connected with the painting process and the active perceiving process.

We know that probably the earliest writer about Jie-rule painting in Chinese art theory is written by a great painter, Gu Kai Zhi (346- 407) in East Jin Dynasty. He said:

Building is a kind of utility with definite shape, although it is laborous to draw, yet easy to draw it well (after you understand the structure of it) because the painter does not have to put fine and witty thought in it.[21]

In this short passage, it reveals an import attitude towards Jieirule painting. The painter has to know the structure of the building first. Even in the most simple modern brochure teaching how to paint Jie-rule painting, the first chapter goes directly to the introduction of the structural system of the traditional Chinese architecture, and then the various parts of the building, such as the roof, the column, the beams and the brackets and so on. Although Galen’s anatomy on the real human body does not become popular in Chinese history because of its cruelty, it gains great success on the body of building.  In fact, the Chinese architect is so fascinated with Galen’s anatomy that in the construction of the interior of the building, no extra veneer or dry wall is added with extra expense and labor. The cruelty of disection was transferred artfully into the beauty of the anatomic structure of the building, and then was pleasantly exposed.

To express the anatomic beauty, the Chinese painter chooses to draw the buildings as open and the interior of which could be easily seen. Thus axonometry becomes the ideal form.